Acute Appendicitis

Etiology
• Acute appendicitis, inflammation of the
appendix, is the most common surgical disease
of the abdomen.
• Appendiceal inflammation is associated with
obstruction usually in the form of a fecolith and
less commonly a gallstone, tumor, or ball of
worms (Oxyuriasis vermicularis).
• It is mainly a disease of adolescents and young
adults, but it may occur in any age group and
affects males slightly more than females.
 Symptoms and clinical signs 
• Pain, at first periumbilical, then localizing
to the right lower quadrant.
• Nausea, vomiting, or both.
• Abdominal tenderness, particularly in the
region of the appendix.
• Fever.
• Elevation of peripheral WBC count up to
15000-20000 cell/cubic mm
(esp.neutrophilia)
 Pathophysiology 
• Continued secretion of mucinous fluid in
the obstructed viscus leads to a
progressive increase in intraluminal
pressure sufficient to cause eventual
collapse of the draining veins.
• Ischemic injury then favors bacterial
proliferation with additional inflammatory
edema and exudation, further reducing the
blood supply
 Gross Appearance
• The organ will be enlarged, edematous
and congested.
• The serosa is hyperemic and coated with
fibrinopurulent exudate
 Histopathology
• There is blood and inflammatory debris within
the lumen.
• Mucosa is mostly destroyed by the inflammatory
reaction.
• The most important feature is neutrophilic
infilteration of the muscularis layer.
• All cardinal signs of acute inflammation are seen
like dilated vessels, collection of edema fluid in
stroma, neutrophilic infilteration of all layers and
sloughing of mucosa.
• Periappediceal inflammation is seen in
advanced cases.
 dilated vessels

muscle layer

Sloughed necrotic mucosa

serosal exudate
 mucosal glands

neutrophilic infilteration
(in all layers)